Comparing Self Monitoring Blood Glucose Devices and Laboratory Tests: Over 25 Years Experience.

Self-monitoring blood glucose (SMBG) devices have been widely used in medical practice for decades. However, there are certain gaps between SMBG device readings and venous blood glucose levels. Here, 3,532 measurement data points were recorded over 25 years to compare SMBG device readings and venous blood glucose levels. The mean absolute difference (MAD) or the GAP was 10.9 mg/dL, and the mean absolute relative difference (MARD) was 8.3%. The absolute relative difference (ARD) (%) and absolute difference (AD or GAP) (mg/dL) coefficients of variation (CV) (%) of 100% indicate high variance between the capillary BG and venous true BG data. There was a slight skewing of MAD and MARD to the lower body mass index (BMI) side, the higher age side, and the female gender side. There were 41 data points that showed unacceptable gaps of over 50 mg/dL. Such large differences may cause incorrect medications or treatments. All healthcare providers should be aware of the gap between SMBG device readings and venous blood glucose levels.

Prognostic factors in clinical T1N0M0 thoracic esophageal squamous cell carcinoma invading the muscularis mucosa or submucosa.

BACKGROUND: Multimodality treatment is widely performed for clinical T1N0M0 (UICC-TNM classification, 7th edition) thoracic esophageal squamous cell carcinoma (ESCC), but available articles regarding treatment results are limited. This study assessed the outcomes of clinical T1N0M0 thoracic ESCC invading the muscularis mucosa (MM) or submucosa (SM) treated with radiotherapy (RT) or chemoradiotherapy (CRT). METHODS: We retrospectively reviewed the medical charts of 90 patients with clinical T1N0M0 thoracic ESCC treated with RT or CRT in our hospital in 2004-2011. Of these 90 patients, we analyzed the cases of 71 patients who met our inclusion criteria. All 71 patients had MM or SM cancer. In the 47 patients treated with CRT, the chemotherapy regimen of 5-fluorouracil (5-FU) plus cisplatin (CDDP) was used for 46 patients and 5-FU and nedaplatin was used for one patient. Forty-five patients underwent endoscopic resection (ER) followed by RT or CRT as an additional treatment. Elective nodal irradiation (ENI) was used in 39 patients. For all analyses, statistical significance was defined as 0.05, and the Bonferroni correction was used for the multivariate analysis. RESULTS: The median age was 70 years (range 47-84). With a median follow-up of 43.6 months (range 1.5-124.2), the 5-year overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) rates were 64.0, 72.8 and 50.0 %, respectively. The multivariate analysis showed that performance status (PS) was an independent prognostic factors for DSS and DFS (DSS, p < 0.001; DFS, p < 0.001). Chemotherapy in addition to RT showed a trend for better DSS (p = 0.032) but was not significant following Bonferroni correction. ER and ENI were not significant predictive factors for DSS and DFS. CONCLUSIONS: PS was an independent prognostic factor for DSS and DFS. ER and ENI had no significant relationship with DSS or DFS. The present results may be helpful in treatment decisions for clinical T1N0M0 thoracic ESCC.

Evaluation of the motion of lung tumors during stereotactic body radiation therapy (SBRT) with four-dimensional computed tomography (4DCT) using real-time tumor-tracking radiotherapy system (RTRT).

PURPOSE: We investigated the usefulness of four-dimensional computed tomography (4DCT) performed before stereotactic body radiation therapy (SBRT) in determining the internal margins for peripheral lung tumors. METHODS AND MATERIALS: The amplitude of the movement of a fiducial marker near a lung tumor measured using the maximum intensity projection (MIP) method in 4DCT imaging was acquired before the SBRT (AmpCT) and compared with the mean amplitude of the marker movement during SBRT (Ampmean) and with the maximum amplitude of the marker movement during SBRT (Ampmax) using a real-time tumor-tracking radiotherapy (RTRT) system with 22 patients. RESULTS: There were no significant differences between the means of the Ampmean and the means of the AmpCT in all directions (LR, P = 0.45; CC, P = 0.80; AP, P = 0.65). The means of the Ampmax were significantly larger than the means of the AmpCT in all directions (LR, P < 0.01; CC, P = 0.03; AP, P < 0.01). In the lower lobe, the mean difference of the AmpCT from the mean of the Ampmax was 5.7 ± 8.0 mm, 12.5 ± 16.7 mm, and 6.8 ± 8.5 mm in the LR, CC, and AP directions, respectively. CONCLUSIONS: Acquiring 4DCT MIP images before the SBRT treatment is useful to establish the mean amplitude for a patient during SBRT but it underestimates the maximum amplitude during actual SBRT. Caution must be paid to determine the margin with the 4DCT especially for tumors at the lower lobe where it is of the potentially greatest benefit.

Dosimetric comparison between intensity-modulated radiotherapy and standard wedged tangential technique for whole-breast radiotherapy in Asian women with relatively small breast volumes.

We sought to investigate whether intensity-modulated radiotherapy (IMRT) has a dosimetric advantage compared to the standard wedged tangential technique (SWT) for whole-breast radiotherapy (WBRT) in Asian women with relatively small breast volume. Computed tomography images of 25 Asian patients with early-stage breast cancer (right 15, left 10) used for WBRT planning were examined. After contouring the target volumes and bilateral lungs and, for left-side treatment, the heart, 4 plans were made for each patient: namely, SWT, tangential-field IMRT (T-IMRT), 3-field IMRT (3F-IMRT), and 4-field IMRT (4F-IMRT). The prescribed dose was 5000 cGy. The median planning target volume (PTV) for WBRT was 552.6 cc (range 288.8-1518.4 cc). Compared to SWT, (1) T-IMRT achieved significant improvement for dose homogeneity in the PTV (p < 0.001) and the dose received by 2% (D2) of the PTV (p < 0.001). T-IMRT also reduced the bilateral lung mean dose (p < 0.001) and the ipsilateral lung volume which received more than 20 Gy (V20) (p = 0.01). (2) 3F-IMRT resulted in a significant increase in the mean dose to the ipsilateral lung (p < 0.001) and to the contralateral lung (p < 0.001). (3) 4F-IMRT also resulted in a significant increase in the mean dose to the ipsilateral lung (p < 0.001) and to the contralateral lung (p < 0.001). Tangential-field IMRT provided an improved dose distribution compared with SWT for WBRT in Asian women with a relatively small breast volume.

Prospective phase II study of image-guided local boost using a real-time tumor-tracking radiotherapy (RTRT) system for locally advanced bladder cancer.

OBJECTIVE: The real-time tumor-tracking radiotherapy system with fiducial markers has the advantage that it can be used to verify the localization of the markers during radiation delivery in real-time. We conducted a prospective Phase II study of image-guided local-boost radiotherapy for locally advanced bladder cancer using a real-time tumor-tracking radiotherapy system for positioning, and here we report the results regarding the safety and efficacy of the technique. METHODS: Twenty patients with a T2-T4N0M0 urothelial carcinoma of the bladder who were clinically inoperable or refused surgery were enrolled. Transurethral tumor resection and 40 Gy irradiation to the whole bladder was followed by the transurethral endoscopic implantation of gold markers in the bladder wall around the primary tumor. A boost of 25 Gy in 10 fractions was made to the primary tumor while maintaining the displacement from the planned position at less than ±2 mm during radiation delivery using a real-time tumor-tracking radiotherapy system. The toxicity, local control and survival were evaluated. RESULTS: Among the 20 patients, 14 were treated with concurrent chemoradiotherapy. The median follow-up period was 55.5 months. Urethral and bowel late toxicity (Grade 3) were each observed in one patient. The local-control rate, overall survival and cause-specific survival with the native bladder after 5 years were 64, 61 and 65%. CONCLUSIONS: Image-guided local-boost radiotherapy using a real-time tumor-tracking radiotherapy system can be safely accomplished, and the clinical outcome is encouraging. A larger prospective multi-institutional study is warranted for more precise evaluations of the technological efficacy and patients' quality of life.

Evaluation of inter-observer variability of bladder boundary delineation on cone-beam CT.

BACKGROUND: In-room cone-beam computerized tomography (CBCT) imaging is a promising method to reduce setup errors, especially in organs such as the bladder that often have large intrafractional variations due to organ movement. CBCT image quality is limited by low contrast and imaging artifacts, but few data have been reported about inter-observer variability of bladder boundary delineation on CBCT. The aim of this work was to analyze and evaluate the inter-observer contouring uncertainties of bladder boundary delineation on CBCT images in a prospective fashion. METHODS: Five radiation oncologists contoured 10 bladders using the CBCT datasets of consecutive 10 patients (including 4 females) who were irradiated to the pelvic region. Prostates were also contoured in male patients. Patients who had had prostatectomy were excluded. The coefficient of variation (COV), conformity index (CI(gen)), and coordinates of center-of-mass (COM) of the bladder and prostate were calculated for each patient. RESULTS: The mean COV for the bladder and prostate was 0.08 and 0.20, respectively. The mean CI(gen) of the bladder and prostate was 0.81 and 0.66, respectively. The root mean square (RMS) of the inter-observer standard deviation (σ) of the COM displacement in the left-right (LR) and anterior-posterior (AP) direction was 0.79, 0.87 and 0.54 for the bladder and 0.63, 0.99 and 1.72 for the prostate. Regarding the mean COV and CI(gen) for the bladder, the differences between males and females were not significant. CONCLUSIONS: Inter-observer variability for bladder delineation on CBCT images was substantially small regardless of gender. We believe that our results support the applicability of CBCT in adaptive radiotherapy for bladder cancer.

Prospective Neural Areas and their Morphogenetic Movements during Neural Plate Formation in the Xenopus Embryo. II. Disposition of Transplanted Ectoderm Pieces of X. borealis Animal Cap in Prospective Neural Areas of Albino X. laevis gastrulae.: (developmental fate/neural plate area/Xenopus embryo/chimera/quinacrine).

Small pieces of the animal cap of X. borealis gastrulae were transplanted into various regions of the noninvoluting marginal zone of albino X. laevis gastrulae, and the distribution of the donor cells was analyzed by quinacrine fluorescence staining. The present study indicated that the prospective central nervous system (CNS) lies as a belt-shaped area in the noninvoluting marginal zone of early gastrulae. This belt-shaped prospective neural area extends as far as 0.7 mm (115° to the vegetal pole) above the blastopore in the dorsal midline and 1.3 mm lateral (130° to the dorsal midline) to the dorsal midline. The ectoderm of the dorsal region extends in the animal-vegetal direction and forms the ventral side of the CNS. The dorsalateral and lateral regions converge toward the dorsal midline and extended in the animal-vegetal direction. The former constitutes the lateral side of the anterior CNS, and the latter the dorso-lateral side of the posterior CNS. The outer layer of ectoderm which was transplanted onto the inner layer of the host gastrula differentiated into neural tissues. The prospective areas of the CNS and their morphogenetic movement during Xenopus embryogenesis are also discussed with regard to neural induction.

Prospective Neural Areas and Their Morphogenetic Movements during Neural Plate Formation of Xenopus Embryos. I. Development of Vegetal Half Embryos and Chimera Embryos: (developmental fates/cell marker, quinacrine/Xenopus embryo).

Development of animal cap-less Xenopus gastrulae was examined. In vegetal halves from which the animal cap was removed 0.6 mm above the blastopore, an apparently normal array of craniocaudal structures developed. Histological examination showed differentiation of central nervous system (CNS) structures in the cap-less embryos, but differentiation of sensory organs, such as a lens and ear vesicle in only a few embryos. Only the dorsal midline of the embryos was covered with epidermis, and its lateral-ventral areas consisted of bare endoderm and mesoderm. The development of animal cap was also investigated by exchanging the animal cap of X. laevis embryos with that of X. borealis embryos, which can be distinguished by quinacrine fluorescence staining. The central nervous system of chimera embryos consisted mainly of X. laevis cells stained homogeneously with quinacrine but a small number of punctately-stained X. borealis cells was in the anterior tip of the forebrain. Cells of the lens and ear vesicle were punctately stained. More than two-thirds of the epidermal area consisted of punctately-stained cells and only the dorsal midline of the posterior head- and trunk-epidermis consisted of homogeneously-stained cells. Areas of the prospective central nervous system and their movement during embryogenesis of Xenopus are discussed.